While federal lawmakers try to revive reform legislation, providers are finding ways to change the delivery model. Hospital networks in different parts of the country are implementing new physician-hospital collaborations. The intent is to bring hospitals and physicians closer together to improve care and control or reduce costs. Two systems at the forefront of this movement say that regardless of what lawmakers accomplish, the collaboration plans are long overdue.

Launched in the fourth quarter of 2009, the Physician Hospital Alignment for Central Oregon brings together more than 250 physicians and Cascade Healthcare Community, the area's main hospital system, to develop a new regional reform model. The plan is expected to drive evidence-based medicine and generate savings. Physicians who join PHA will be considered preferred providers for all noncontract CHC caregivers. The aim is to reduce overutilization. One of the first steps is to create a health care information exchange so all providers in the community can share patient records.

Baylor Health Care System in North Texas is taking a different approach. The health system in late November announced that it was forming an accountable care organization among its 14 hospitals and 4,500 network physicians. In Baylor's model, physicians and hospitals share a financial incentive to control costs and improve quality by coordinating care for a patient group. Baylor expects to have all of its hospitals on the same electronic record system by 2011.

A major barrier to reform is the current fee-for-service payment structure, says Elliott Fisher, M.D., a leader in the ACO concept, and director of population health and policy at Dartmouth's Institute for Health Policy and Clinical Practice. Both Baylor and PHA expect to eventually overhaul their payment models so there is a financial incentive to control costs and improve quality.

"The initial focus is not on contracts or bundled payments. We would like the organization to be positioned for that in the future," says Gary Brock, Baylor's chief operating officer.

Cascade is in a similar situation. "We are just getting started and laying the foundation to build an integrated delivery system," says James A. Diegel, president and CEO of CHC. Cascade is looking to its physician community to provide a lot of the leadership for the new effort, he adds.

Eventually, savings from the new efficiencies will be used to stabilize reimbursement for all the stakeholders, promote preventive treatments or build a more efficient medical home model.

It is also important to have a measurement and data system available to support health care improvement, says Fisher. Officials at both health systems say they are working toward that goal.